Attending Need, Not Profit: Venezuela’s Experiment with Community Medicine

Published on venezuelanalysis (also on ZNet), by Ewan Robertson, Oct 14, 2013.

How should the healthcare needs of a society be met? Conspicuously absent from international media coverage and under fire from conservative critics at home, Venezuela is developing a public healthcare system distinct from both U.S. market-driven and European welfare-state models. Perhaps nothing makes this system more unique than the kind of doctors being trained to run it.

The first remarkable thing to note about Venezuela’s comprehensive community medicine program is how little is known about it outside of Venezuela. The attempt to train tens of thousands of aspiring doctors in Cuban-style preventative community medicine, the majority of these new physicians from lower-income backgrounds, has merited next to no attention from the international mass media. Compared to issues of crime, inflation and sporadic shortages in the economy, for these outlets the effort to create an “army of white jackets” to make the vision of a free, universal healthcare service with clinics in every neighbourhood a reality is seemingly not of importance for understanding Venezuela today.

Yet Venezuela’s new community doctors are now central to the performance and future shape of the country’s revitalised public healthcare system. Further, at a time when medicine is usually a vocation only open to elites and public healthcare services are being increasingly fractured and privatised by anti-popular governments, the Venezuelan example of constructing a robust public healthcare system in often difficult circumstances is demonstrative on a global level.

In progressive and independent media important work has already been done to open the world’s eyes to new programs offering free public healthcare in Venezuela. This article focuses on the next stage of this project: the training of tens of thousands of new doctors under the Cuban-supported comprehensive community medicine program. With the first wave of community doctors graduating in December 2011, these are the professionals who are now developing the country’s new national public healthcare system, from local community clinics to hospital level. Between the following article and direct interviews with graduates, this investigation aims to shine a light on Venezuela’s, and indeed Latin America’s, new type of doctor: their quality, their values, and their future vision for healthcare in Venezuela and the wider world.

The Origins of Medicina Integral Comunitaria (MIC) in Venezuela: …//

… Aspects and Goals of Comprehensive Community Medicine: … //

… Evaluating the Program: … //

… Concluding Thoughts:

The Venezuelan government’s effort to establish a new medical education program from the ground up and train tens of thousands of doctors for the country’s revitalised public health system has been a bold initiative, and one whose benefit is now being seen the length and breadth of the country. Of course the program has had to confront many obstacles and difficulties, such as an initial lack of infrastructure, the requirement for practicing Cuban doctors to take on the demanding task of teaching a new curriculum, and a hostile attitude from the traditional medical establishment. Further, given the experimental nature of comprehensive community medicine in its early phases and the expectation for students to engage in a great amount of independent study, there are likely some graduates who are not fully up to standard; something which such individuals will have to confront in their two years of residency. Nevertheless, the same could also likely be said of some graduates from the country’s traditional medical schools.

However based on the information available and in concordance with the anecdotal findings of this investigation, the great majority of Venezuela’s new community doctors appear to be humane, well trained, and professionally competent. The evidence suggests that it is now falling on the traditional sector to accept that many of their comprehensive community colleagues are far better trained than they had originally imagined, and that much of the criticism aimed at the MIC program has proven to be unfair at best, and deliberately misleading at worst. Many conventional doctors will have been shocked when in a recent competition to enter postgraduate study in the prestigious University of the Andes in Mérida, three of the four community doctors who applied were accepted to the forty-something places offered, while up to two hundred graduates from traditional universities were not.

By 2019 it is possible that around 60,000 community doctors will be working in Venezuela’s free public healthcare system, following what Social Medicine Journal describes as “the most ambitious example of scaling up of physician training in a single country”.[vi] This is a huge investment of resources for a country that, despite its oil income, is regarded as belonging to the “third world” with multiple challenges to its development. While in many nations the political class informs the population that the resources do not exist to support public healthcare and that the private sector must play an ever greater role in healthcare delivery, Venezuela’s experiment with community medicine offers a different path. With the political will it is indeed possible to guarantee all members of society the right to free healthcare, and it is also possible to train the doctors needed to ensure this service is humane, professional, and public. Perhaps that’s why not a squeak about comprehensive community medicine has been heard from in the international mainstream media up to now.

Beyond what the Venezuelan government, the traditional medical establishment and foreign observers have concluded about comprehensive community medicine, this investigation invites readers to look at what recently-graduated community doctors themselves think about the program. In the second part of this study these new professionals from all walks of life give their first-hand accounts of their training and their experiences working alongside conventional doctors in the nation’s public hospitals. The interviews also reveal a lot about the values and future aspirations of Venezuela’s “army in white jackets”.

(full long text with hyper-links and notes).

Links:

Venezuela Receives 320 Technicians from the FAO
: Maduro Sets Sights on 80,000 Urban Agriculture Projects, on venezuelanalysis , by Ryan Mallett-Outtrim, Oct 19, 2013;

What GOP-Tea Party Risks With Block of New New Deal, on truthout, by Richard D. Wolff, Oct 13, 2013;
on the same page, in the right column: sign the petition ‘Stop Landgraps for Sugar Production’ – (see it also on Facebook).

(see also: Welcome to our new blog: politics for the 99%).

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